Individual
MS. VICTORIA MAE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 NE 177TH ST, NORTH MIAMI BEACH, FL 33162-1914
(786) 423-7033
Mailing address
400 NE 177TH ST, NORTH MIAMI BEACH, FL 33162-1914
(786) 423-7033
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7636
—
FL
Enumeration date
02/06/2020
Last updated
02/06/2020
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